We want to offer the following reminders on pain management and opioid antagonists.
Pain management plans and alternative therapies
For individuals who are experiencing persistent pain, pain management plans can be vital in providing education on individualized treatment options, offering a structured approach to pain management, reducing reliance on opioids, and empowering patients to actively participate in their care. Pain management plans often include a variety of strategies beyond medication to address the underlying causes of pain and promote long-term pain control.
When developing a pain management plan with patients, keep in mind that Point32Health covers a broad range of non-medication, non-surgical, and non-opioid medication treatment options — such as acupuncture, behavioral therapy, physical therapy, and chiropractic medicine — for patients living with chronic pain.
Providers can check member eligibility and benefits through our secure HPHConnect and Tufts Health Plan provider portals. Members also have access to information about their benefits, including pain management services, through their member handbooks which are posted on our member websites or portals. In addition, our online Chronic Pain resource is available for Harvard Pilgrim Health Care Commercial members.
Coverage and billing of opioid antagonists
Given that opioid use can lead to misuse and addiction, it’s important to note as well that Point32Health provides coverage of opioid antagonists (medications that block the effects of opioids), such as naloxone and naltrexone. Naloxone is used to reverse the effects of opioid overdose, while naltrexone is used longer term to prevent relapse in patients with alcohol use disorder or an opioid use disorder.
For coverage details, please refer to the applicable formulary and any relevant Pharmacy Medical Necessity Guidelines or other policies.
Please ensure that you are billing with the appropriate codes, and keep in mind that in some cases, reimbursement may occur as part of a bundled rate (for example, when billing for naloxone with J0571-J0575 or J2310-J2311). In addition, providers should follow the claims and billing guidance outlined in the applicable Provider Manual.